Selective placement of novel compression suture technique to reduce pacemaker implantation rate following surgical aortic valve replacement with rapid deployment INTUITY valve

Kelvin Jeason Yang; Chih-Hsien Wang; Hsiao-En Tsai; Sheng-Pin Yu; Yih-Sharng Chen; Nai-Hsin Chi

doi:10.1016/j.jfma.2024.03.002

Selective placement of novel compression suture technique to reduce pacemaker implantation rate following surgical aortic valve replacement with rapid deployment INTUITY valve

J Formos Med Assoc. 2024 Mar 12:S0929-6646(24)00147-5. doi: 10.1016/j.jfma.2024.03.002. Online ahead of print.

Authors

Kelvin Jeason Yang¹, Chih-Hsien Wang², Hsiao-En Tsai³, Sheng-Pin Yu⁴, Yih-Sharng Chen², Nai-Hsin Chi⁵

Affiliations

¹ Department of Cardiovascular Surgery, Taipei Tzu-Chi Hospital, Tzu-Chi University, Taiwan; Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan.
² Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan.
³ Department of Cardiovascular Surgery, National Taiwan University Hospital, Hsin-Chu Branch, Taiwan.
⁴ Department of Cardiovascular Surgery, National Taiwan University Hospital, Yun-Lin Branch, Taiwan.
⁵ Department of Cardiovascular Surgery, National Taiwan University Hospital, Taipei, Taiwan. Electronic address: chinaihsin@gmail.com.

PMID: 38480086
DOI: 10.1016/j.jfma.2024.03.002

Abstract

Objective: The use of RDV in SAVR is associated with risk of conduction abnormality requiring PPM implantation, when compared to conventional bioprosthetic valves. We aimed to evaluate the outcome after selective placement of annular compression sutures during surgical aortic valve replacement (SAVR) using Intuity rapid deployment valve (RDV).

Methods: This is a retrospective study of prospectively enrolled patients receiving SAVR using Intuity RDV. Selective placement of commissural compression suture was assessed for all patients based on their annular morphology. Outcomes including operative mortality, rate of pacemaker rate, paravalvular leak and change in trans-valvular pressure gradient were analyzed.

Results: 56 consecutive patients underwent SAVR with the INTUITY RDV at our institution from January 2020 to November 2021. The Mean age of our cohort was 69.9 ± 10.6 years with a EuroSCORE II of 3.4 ± 2.4%. 28.6% (16/56) of patients had notable conduction abnormalities pre-operatively, which included atrial fibrillation and left/right bundle branch block. Compression sutures were selectively applied in 19/56 (33.9%) patients. Of which, 13 were bicuspid aortic valve. Post-operatively, we observed no conduction abnormality requiring PPM implantation. In addition, only 3 of the 56 (5.4%) had any degree of paravalvular leak on post-operative echocardiography (all ≤ mild). The mean reduction in trans-valvular gradient was 29.9 mmHg and the mean pressure gradient at 1 month and 1 year follow-up were 9.3 ± 3.6 mmHg and 10.2 ± 4.1 mmHg, respectively.

Conclusions: Selective placement of compression suture helps to avoid unnecessary oversizing, which may reduce the risk of paravalvular leak and post-operative PPM implantation.

Keywords: Compression suture; Permanent pacemaker implantation; Rapid deployment valve; Surgical aortic valve replacement; Sutureless bioprosthetic valve.